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Williams CM, Welch JJ, Scheper M, Tofts L, Pacey V. Variability of joint hypermobility in children: a meta-analytic approach to set cut-off scores. Eur J Pediatr 2024; 183:3517-3529. [PMID: 38801562 PMCID: PMC11263245 DOI: 10.1007/s00431-024-05621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
Current international consensus of the appropriate Beighton score cut-off to define if a child has generalised joint hypermobile or not is based upon expert opinion. Our aim was to determine the prevalence of Beighton scores of children worldwide to provide a recommendation for establishing the Beighton score cut-off to identify generalised joint hypermobility in children. We used AMED, OVID Medline, Embase and CINAHL to find published articles from inception to April 2024 describing Beighton scores of children up to and including 18 years from the general population. We extracted study demographics including country of publication, total number of participants, summary data about the age and sex of participant, Beighton scores and any cut-off used where authors deemed children hypermobile and how many children were rated at the corresponding Beighton scores. There were 37 articles reporting on the prevalence or incidence of hypermobility at cut-off scores from 28,868 participants. Using the cut-off of ≥ 6 resulted in a prevalence of 6% for studies reporting male data and 13% for studies reporting female data. Limited data reporting availability precluded further sub-analysis at a Beighton score of ≥ 7, age, pubertal status and ethnicity. Conclusion: The working threshold for identifying generalised joint hypermobility in children should be a Beighton score of 6 or more. Our analysis also suggests a Beighton score of 7 or greater may be appropriate in childhood, particularly for females. What is Known: • The working threshold for identifying generalised joint hypermobility in children previously was set based on expert opinion. What is New: • The threshold to identify hypermobility in children should be at a minimum of ≥ 6 on the Beighton score.
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Affiliation(s)
- Cylie M Williams
- School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - James J Welch
- Ablefeet, 16 Terrace Road, Walton-on-Thames, Surrey, KT12 2SB, UK
| | - Mark Scheper
- Research Center Innovations in Care, Data Supported Healthcare, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia
- Institute for Communication, Media and Information Technology, Program Responsible AI, Rotterdam University of Applied Sciences Rotterdam, Rotterdam, The Netherlands
- Livinglab Responsible AI, Creating010, Rotterdam University of Applied Sciences Rotterdam, Rotterdam, The Netherlands
| | - Louise Tofts
- Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia
| | - Verity Pacey
- School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
- Department of Health Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, NSW, 2113, Australia
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Hypermobility in Turkish schoolchildren: Musculoskeletal pain, physical activity, balance, and quality of life. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1067861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kolacz J, Kovacic K, Lewis GF, Sood MR, Aziz Q, Roath OR, Porges SW. Cardiac autonomic regulation and joint hypermobility in adolescents with functional abdominal pain disorders. Neurogastroenterol Motil 2021; 33:e14165. [PMID: 33991431 DOI: 10.1111/nmo.14165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Joint hypermobility (JH) is associated with autonomic nervous system dysregulation and functional abdominal pain disorders (FAPDs). Understanding the neurophysiological processes linking these conditions can inform clinical interventions. Autonomic activity regulates gastrointestinal (GI) sensorimotor function and may be a key mechanism. The aims of this study were to examine the relation of JH with dynamic autonomic activity and parasympathetic regulation in adolescents with FAPDs and identify optimal JH cutoff scores that best index autonomic regulation in FAPDs. METHODS A total of 92 adolescents with FAPDs and 27 healthy controls (age 8-18 years; 80% female) were prospectively enrolled. JH was assessed by Beighton scores. ECG recordings were conducted during supine, sitting, and standing posture challenges. ECG-derived variables-heart period (HP), respiratory sinus arrhythmia (RSA), and vagal efficiency (VE)-were analyzed using linear regression and mixed effects modeling. KEY RESULTS Beighton scores of ≥4 optimally distinguished autonomic function. Adolescents with FAPD and JH had reduced VE compared to adolescents with FAPDs without JH (B = 18.88, SE = 6.25, p = 0.003) and healthy controls (B = 17.56, SE = 8.63, p = 0.044). These subjects also had lower and less dynamic RSA and HP values during posture shifts, with strongest differences in supine position and using the VE metric. CONCLUSIONS & INFERENCES Suboptimal autonomic regulation indexed by reduced vagal efficiency may be a mechanism of symptoms in hypermobile FAPD patients with Beighton score ≥ 4. Autonomic disturbance may serve as potential intervention target for patients with JH and functional GI disorders.
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Affiliation(s)
- Jacek Kolacz
- Socioneural Physiology Laboratory, Kinsey Institute, Indiana University, Bloomington, IN, USA.,Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Katja Kovacic
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, IL, USA
| | - Gregory F Lewis
- Socioneural Physiology Laboratory, Kinsey Institute, Indiana University, Bloomington, IN, USA.,Intelligent Systems Engineering, Indiana University, Bloomington, IN, USA
| | - Manu R Sood
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, IL, USA
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Olivia R Roath
- Socioneural Physiology Laboratory, Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Stephen W Porges
- Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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4
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Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int 2021; 41:1707-1716. [PMID: 33738549 PMCID: PMC8390395 DOI: 10.1007/s00296-021-04832-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
The Beighton Score (BS) is a set of manoeuvres in a nine-point scoring system, used as the standard method of assessment for Generalised Joint Hypermobility (GJH). It was originally developed as an epidemiological tool used in screening large populations for GJH, but later adopted as a clinical tool for diagnostic purposes. Its ability to truly reflect GJH remains controversial, as joints within the scoring system are predominantly of the upper limb and disregard many of the major joints, preventing a direct identification of GJH. Furthermore, a consistent finding in the literature whereby the BS failed to identify hypermobility in joints outside the scoring system suggests its use as an indirect indicator of GJH is also not viable. As such, the collective findings of this review demonstrate a need for a change in clinical thinking. The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH. Greater emphasis should be placed on a clinician’s judgement to identify or exclude GJH, according to its full definition.
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Affiliation(s)
- Sabeeha Malek
- Centre for Mechanochemical Cell Biology, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | | | - Gemma S Pearce
- Faculty of Health and Life Sciences, School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, CV1 5FB, UK
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Something Scary Is Out There: Remembrances of Where the Threat Was Located by Preschool Children and Adults with Nighttime Fear. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2021. [DOI: 10.1007/s40806-021-00279-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractYoung children frequently report imaginary scary things in their bedrooms at night. This study examined the remembrances of 140 preschool children and 404 adults selecting either above, side, or below locations for a scary thing relative to their beds. The theoretical framework for this investigation posited that sexual-size dimorphism in Australopithecus afarensis, the presumed human ancestor in the Middle Pliocene, constrained sleeping site choice to mitigate predation. Smaller-bodied females nesting in trees would have anticipated predatory attacks from below, while male nesting on the ground would have anticipated attacks from their side. Such anticipation of nighttime attacks from below is present in many arboreal primates and might still persist as a cognitive relict in humans. In remembrances of nighttime fear, girls and women were predicted to select the below location and males the side location. Following interviews of children and adult questionnaires, multinomial log-linear analyses indicated statistically significant interactions (p < 0.001) of sex by location for the combined sample and each age class driven, in part, by larger frequencies of males selecting the side location and females selecting the below location. Data partitioning further revealed that males selected the side location at larger frequencies (p < 0.001) than the below location, whereas female selection of side and below locations did not differ significantly. While indicative of evolutionary persistence in cognitive appraisal of threat locations, the female hypothesis did not consider natural selection acting on assessment of nighttime terrestrial threats following the advent of early Homo in the Late Pliocene.
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Sobhani-Eraghi A, Motalebi M, Sarreshtehdari S, Molazem-Sanandaji B, Hasanlu Z. Prevalence of joint hypermobility in children and adolescents: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:104. [PMID: 33824669 PMCID: PMC8019126 DOI: 10.4103/jrms.jrms_983_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 12/31/2019] [Accepted: 06/21/2020] [Indexed: 11/06/2022]
Abstract
Background: The inconsistent results of different studies regarding the prevalence of joint hypermobility (JH) or joint laxity in children and adolescents made us conduct a meta-analysis on the prevalence of JH in this age group. Materials and Methods: We searched electronic databases including Trip, Scopus, Medline, Embase, PubMed, and Google Scholar; some Iranian databases including Iran Medex and Magiran; and Scientific Information Database to find studies in which the prevalence of JH in children and adolescents had been reported since January 1990 to April 2017. In this process, two researchers evaluated the articles separately while they were not aware of each other's method, and they extracted and matched the information. Results: Necessary data of twenty studies (15,097 boys and 6048 girls) were entered into this meta-analysis. The age range in these studies was 3–19 years. According to the meta-analysis conducted on the twenty studies, it was determined that the total prevalence of JH among children and adolescents was 34.1% (95% confidence interval [CI]: 33.3%–34.8%). Based on the results obtained from the studies, a significant heterogeneity (I2 index equals to 99,415 and P ≤ 0.001) was shown, so we used random-effects model; moreover, the overall assessment of studies showed a statistically significant publication bias (P = 0.02). In total, the prevalence in girls was equal to 32.5% (95% CI: 31.4%–33.7%), and in boys, it was equal to 18.1% (95% CI: 17.2%–19.1%). Conclusion: According to this meta-analysis, studies showed high heterogeneity, and the prevalence of JH in children and adolescents around the world was equal to 34.1% (95% CI: 33.3%–34.8%) in total, whereas it was higher in girls and lower in older ages.
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Affiliation(s)
- Amir Sobhani-Eraghi
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Motalebi
- Department of Medicine, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Siavash Sarreshtehdari
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Borzooyeh Molazem-Sanandaji
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hasanlu
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Sirajudeen MS, Waly M, Alqahtani M, Alzhrani M, Aldhafiri F, Muthusamy H, Unnikrishnan R, Saibannavar R, Alrubaia W, Nambi G. Generalized joint hypermobility among school-aged children in Majmaah region, Saudi Arabia. PeerJ 2020; 8:e9682. [PMID: 32864212 PMCID: PMC7427539 DOI: 10.7717/peerj.9682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Generalized joint hypermobility (GJH) is common among schoolchildren and usually benign. However, it may progressively lead to joint pain and developmental delay. Identifying GJH in school-aged children would facilitate the monitoring of early changes and planning for early rehabilitative intervention. Epidemiological studies addressing the prevalence of GJH among children in the Gulf region and Arab ethnicity are lacking. Hence, we aimed to determine the prevalence, pattern, and factors associated with GJH among school-aged children in the Majmaah region, Saudi Arabia. Male and female school-aged children 8–14 years of age from the Majmaah region of Saudi Arabia participated in this cross-sectional study. Beighton score was used to assess GJH. Personal characteristics such as age, height, weight, body mass index, and handedness were also collected. Descriptive statistics were obtained for personal characteristics, the point prevalence of hypermobility, frequency of Beighton score distribution, and prevalence of GJH. The associations between specific factors and the presence of GJH were analyzed using chi-square and Mann-whitney tests. Using the Beighton score cutoff ≥ 4 and ≥ 6, 15.2% and 7.6% of the school children in our study were diagnosed with GJH respectively. The prevalence of GJH was higher among females (16.8%) than among males (13.4%), but the difference was not statistically significant. The elbow joints (17.2%) were the most common hypermobile joints and the trunk (0.7%) was the least involved. The children with GJH were younger and had lesser BMI compared to children without GJH (P < 0.05). The prevalence reported in this study among school-aged children was comparable with those reported worldwide.
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Affiliation(s)
- Mohamed Sherif Sirajudeen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Mohamed Waly
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Fahad Aldhafiri
- Department of Public Health, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Hariraja Muthusamy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Radhakrishnan Unnikrishnan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Rashmi Saibannavar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Wafa Alrubaia
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudi Arabia
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8
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Corten L, Ferguson G, Smits-Engelsman B. Does the item 'hands on floor' add value to the Beighton score in identifying joint hypermobility? Eur J Rheumatol 2020; 7:79-83. [PMID: 32644928 DOI: 10.5152/eurjrheum.2020.19185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Different assessment tools are used to screen for joint hypermobility. One of the most commonly used tools is the Beighton score. However, the inclusion of the item "hands on floor" (HOF) has been questioned, as this maneuver is not a pure measure of the range of motion because it involves multiple joints and stretching of muscular structures. This study therefore aimed to determine the value of the HOF item to the Beighton score in children aged 6-11 years. METHODS Exploratory research involved children in Grades 1-4 attending four different primary schools in South Africa. Children with a severe medical or neurological condition were excluded from the study. Hypermobility was determined as a score ≥5/8 on the Beighton score excluding the HOF item. RESULTS A total of 460 children (median age 8.58 years [interquartile range, 7.33-9.50]) were tested, of which 34.57% were hypermobile. However, only 8.91% of all children scored positive on HOF. Although a significant association was found between HOF and the hypermobility classification (p=0.007), 86.16% of the hypermobile children could not place their hands flat on the floor. Internal consistency improved slightly when HOF was removed from the scale (α changed from 0.698 to 0.703), with a weak corrected item-total correlation (r=0.16). The specificity of the item HOF in identifying hypermobility is high (93.69%); however, the sensitivity is very low (13.84%). CONCLUSION This study does not show an additional value of the item HOF of the Beighton score in children.
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Affiliation(s)
- Lieselotte Corten
- Department of Physiotherapy, School of Health Sciences, University of Brighton, Eastbourne, United Kingdom.,Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Gillian Ferguson
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bouwien Smits-Engelsman
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
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9
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Reuter PR, Fichthorn KR. Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students. PeerJ 2019; 7:e7625. [PMID: 31565567 PMCID: PMC6744937 DOI: 10.7717/peerj.7625] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/06/2019] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to investigate the prevalence of generalized joint hypermobility (GJH) in a university-aged population, whether young adults (aged 18–25 years) with GJH are prone to sustain more musculoskeletal injuries, and are more likely to suffer from chronic musculoskeletal pain. The study used an interactive survey to gather data; GJH was assessed using a cut-off Beighton score of ≥5 in accordance with the 2017 International Classification of EDS criteria. The analyzed sample consisted of 482 female and 172 male participants from Florida Gulf Coast University (USA). The prevalence of GJH in a university-aged population can be estimated at 12.5%. Women did not have higher rates of GJH than men. However, female participants showed significantly higher rates of hypermobility of the spine as well as the right knee and elbow joints. The Beighton scores did not differ by ethnicity/race. Female participants had a lower rate of self-reported injuries than male participants, although this difference was not significant. There was no difference in the proportion of all participants classified within different categories (0; 1–4; 5–9) of Beighton scores and whether or not they reported having been injured. Male and female participants reported chronic pain of joints and neck or back at the same rates across the Beighton score categories. Female participants, however, reported higher pain intensity for chronic neck and back pain. This study increases knowledge about a correlation between GJH, musculoskeletal injuries, and chronic pain of joints, neck, and back in a university-aged population.
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Affiliation(s)
- Peter R Reuter
- Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Kaylee R Fichthorn
- Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, FL, USA
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Moore N, Rand S, Simmonds J. Hypermobility, developmental coordination disorder and physical activity in an Irish paediatric population. Musculoskeletal Care 2019; 17:261-269. [PMID: 31062457 DOI: 10.1002/msc.1392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The primary aim of the study was to explore the prevalence of generalized joint hypermobility (GJH) and generalized hypermobility spectrum disorder (gHSD) using the new classification system in a community paediatric physiotherapy service in Ireland. The second aim was to explore the relationship between GJH, gHSD and physical activity level, while considering the association of probable developmental coordination disorder (pDCD). METHODS A case-controlled cross-sectional study of children aged 6-12 years, recruited from the community paediatric physiotherapy department (n = 32) and a local school (n = 41), was carried out. A Beighton score of ≥6/9 distinguished GJH. The new framework for hypermobility spectrum disorder (HSD) was used. Self-reported physical activity level was measured using the Physical Activity Questionnaire-Older Children. A parent-reported validated questionnaire screened for pDCD. RESULTS The prevalence of GJH was 21.9% of children attending physiotherapy. One child in the physiotherapy group was identified as having gHSD, with a prevalence of 3.1%. There was no significant difference in physical activity level between children with and without GJH attending physiotherapy (independent samples t-test, p = 0.28). Probable developmental coordination disorder (pDCD) was observed in 71.9% of children attending physiotherapy. There was no significant difference in the number of children with pDCD in those with and without GJH (Fisher's exact test, p = 0.370). CONCLUSIONS This study was the first to explore the prevalence of GJH and gHSD in the paediatric physiotherapy population in Ireland. The presence of GJH did not affect self-reported physical activity level or motor coordination in children attending physiotherapy.
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Affiliation(s)
- Nicola Moore
- Community Paediatric Physiotherapy Department, Mitchels Integrated Services Building, Tralee, Ireland
| | - Sarah Rand
- Community Paediatric Physiotherapy Department, Mitchels Integrated Services Building, Tralee, Ireland
| | - Jane Simmonds
- Community Paediatric Physiotherapy Department, Mitchels Integrated Services Building, Tralee, Ireland
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Bale P, Easton V, Bacon H, Jerman E, Watts L, Barton G, Clark A, Armon K, MacGregor AJ. The effectiveness of a multidisciplinary intervention strategy for the treatment of symptomatic joint hypermobility in childhood: a randomised, single Centre parallel group trial (The Bendy Study). Pediatr Rheumatol Online J 2019; 17:2. [PMID: 30621718 PMCID: PMC6325876 DOI: 10.1186/s12969-018-0298-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/10/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Joint hypermobility is common in childhood and can be associated with musculoskeletal pain and dysfunction. Current management is delivered by a multidisciplinary team, but evidence of effectiveness is limited. This clinical trial aimed to determine whether a structured multidisciplinary, multisite intervention resulted in improved clinical outcomes compared with standard care. METHOD A prospective randomised, single centre parallel group trial comparing an 8-week individualised multidisciplinary intervention programme (bespoke physiotherapy and occupational therapy in the clinical, home and school environment) with current standard management (advice, information and therapy referral if deemed necessary). The primary endpoint of the study was between group difference in child reported pain from baseline to 12 months as assessed using the Wong Baker faces pain scale. Secondary endpoints were parent reported pain (100 mm visual analogue scale), parent reported function (child health assessment questionnaire), child reported quality of life (child health utility 9-dimensional assessment), coordination (movement assessment battery for children version 2) and grip strength (handheld dynamometer). RESULTS 119 children aged 5 to 16 years, with symptomatic hypermobility were randomised to receive an individualised multidisciplinary intervention (I) (n = 59) or standard management (S) (n = 60). Of these, 105 completed follow up at 12 months. No additional significant benefit could be shown from the intervention compared to standard management. However, there was a statistically significant improvement in child and parent reported pain, coordination and grip strength in both groups. The response was independent of the degree of hypermobility. CONCLUSION This is the first randomised controlled trial to compare a structured multidisciplinary, multisite intervention with standard care in symptomatic childhood hypermobility. For the majority, the provision of education and positive interventions aimed at promoting healthy exercise and self-management was associated with significant benefit without the need for more complex interventions. TRIAL REGISTRATION The trial was registered prospectively with the national database at the Clinical Research Network (UKCRN Portfolio 9366). The trial was registered retrospectively with ISRCTN ( ISRCTN86573140 ).
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Affiliation(s)
- Peter Bale
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK.
| | - Vicky Easton
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Holly Bacon
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Emma Jerman
- grid.439334.aNorfolk Community Health and Care NHS Trust, Norwich, UK
| | - Laura Watts
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK ,0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Garry Barton
- 0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- 0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
| | - Kate Armon
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK
| | - Alex J. MacGregor
- grid.240367.4Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, UK ,0000 0001 1092 7967grid.8273.eNorwich Medical School, University of East Anglia, Norwich, UK
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12
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Antonio DH, Magalhaes CS. Survey on joint hypermobility in university students aged 18-25 years old. Adv Rheumatol 2018; 58:3. [PMID: 30657079 DOI: 10.1186/s42358-018-0008-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Joint hypermobility is defined as a wide range of movements beyond the physiological limits, it has been recognized in healthy people, gymnasts, acrobats, and carriers of genetic affections of connective tissue. A survey among young adults was conducted to describe the frequency of joint hypermobility, estimating its impact on function and quality of life. METHODS Volunteer university students aged 18 to 25 years old who answered a valid 5-item questionnaire about hypermobility, a physical activity questionnaire, and the Brazilian version of the Medical Outcome Survey Short Form 36 (SF-36) were included. Hypermobility was also assessed by a guided self-examination, with Beighton's criteria being scored and scores greater than or equal to 4 or less than 4 being discriminated. RESULTS A total of 388 subjects were included, of which 299 were women (77.06%) and 89 were men (22.94%); the median age was 23 years old. Generalized joint hypermobility (Beighton score ≥ 4) was observed in 104 individuals (26.8%). Localized hypermobility (Beighton score 1-3) was observed in 135 (34.79%) individuals, where the hypermobility of the 5th finger was the most frequent in 165 (57.47%) individuals, followed by hypermobility of the thumb in 126 (32.56%) individuals, hypermobility of the elbows and knees each in 72 (18.6%) individuals, and hypermobility of the spine in 69 (17.79%) individuals. The descriptive observation of physical activity indicated regular practice. The correlation coefficients between the SF-36 domains and hypermobility scores were very low and statistical comparison not significant. CONCLUSION In this population of youngsters, predominantly women, localized hypermobility was more frequent than generalized hypermobility; however, with low impact on health domains and quality of life scores, estimated in each domain of the SF-36, the physical and mental component scores, and the time dedicated to physical activity.
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Affiliation(s)
- Darcisio Hortelan Antonio
- Pediatrics Department, Botucatu Medical School, Graduate Program in Public Health of UNESP, Sao Paulo State University UNESP, Avenida Prof. Mario Rubens Guimarães Montenegro SN, Campus da Unesp, Rubião Junior, CEP, Botucatu, SP, 18618-687, Brazil
| | - Claudia Saad Magalhaes
- Pediatrics Department, Botucatu Medical School, Graduate Program in Public Health of UNESP, Sao Paulo State University UNESP, Avenida Prof. Mario Rubens Guimarães Montenegro SN, Campus da Unesp, Rubião Junior, CEP, Botucatu, SP, 18618-687, Brazil.
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Benhamu-Benhamu S, Garcia-de-la-Peña R, Gijon-Nogueron G, Jimenez-Cristino MD, Gordillo-Fernández LM, Dominguez-Maldonado G. Range of Ankle Dorsiflexion in a Group of Adults with Ligamentous Laxity. J Am Podiatr Med Assoc 2018; 108:245-252. [PMID: 29932759 DOI: 10.7547/16-060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group. METHODS The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded. RESULTS The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group. CONCLUSIONS In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.
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Singh H, McKay M, Baldwin J, Nicholson L, Chan C, Burns J, Hiller CE. Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population. Rheumatology (Oxford) 2017; 56:1857-1864. [DOI: 10.1093/rheumatology/kex043] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/13/2022] Open
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Hypermobility and Musculoskeletal Pain in Adolescents. J Pediatr 2017; 181:213-221.e1. [PMID: 27863848 DOI: 10.1016/j.jpeds.2016.09.060] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/23/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of generalized joint hypermobility (GJH) in a large cohort of Australian children and determine the associations between GJH and musculoskeletal pain. STUDY DESIGN This is a cross-sectional analysis of the Western Australian Pregnancy Cohort (Raine) Study. Hypermobility was measured in 1584 participants at 14 years of age using the Beighton scoring system, along with a range of other factors including musculoskeletal pain status. Logistic regression models were used to assess independent associations of GJH with factors of interest. RESULTS The prevalence of GJH was 60.6% and 36.7% in girls and boys, respectively, when defined as a Beighton score of ≥4; when defined as ≥6, it was 26.1% and 11.5%. In girls, positive associations between GJH and higher socioeconomic status and better motor competence were observed. In boys, positive associations between GJH and lower body mass index were observed. After adjusting for potential confounders, an association between number of pain areas in the last month and made worse with sport were identified in boys but not girls. CONCLUSION The high prevalence rates of GJH as defined by commonly used Beighton cutoff values in this cohort highlight the need to question the appropriateness of these cutoffs in future studies. Future prospective studies of the association between GJH and musculoskeletal pain should be adjusted for confounding variables identified in this study, and be powered for sex-specific analyses owing to the differing prevalence rates and hypermobility correlates in male and female samples.
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Sabui TK, Samanta M, Mondal RK, Banerjee I, Saren A, Hazra A. Survey of musculoskeletal abnormalities in school-going children of hilly and foothill regions of Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine screening method. Int J Rheum Dis 2016; 21:1127-1134. [PMID: 27306925 DOI: 10.1111/1756-185x.12897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the prevalence and pattern of musculosketetal abnormalities in school-going children living in the hilly and foothill regions of the Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine (pGALS) screening tool. METHODS Total of 3608 children, aged 3-12 years were enrolled from 16 schools (5 in the hills) in the eastern Himalayan region. After the three screening questions, the pGALS maneuvers were administered. Subjects were shown a video on pGALS before the actual testing. Those detected to have abnormality were probed in greater detail and referred for treatment as necessary. RESULTS The pGALS examination was completed in 3463 children with a median time of 3 min (range 1.9-5.4 min). The abnormality pattern was in the order: growing pains (38.86%), hypermobility (25.54%), mechanical pains (24.46%) and others (11.14%). Among mechanical pain, back and neck problems occurred with a similar overall frequency of 7.61%. Similar order was observed considering only children from the pains. However, in hill children, the proportion of mechanical problems (32.28%) exceeded proportion of hypermobility (23.62%). Asymptomatic hypermobility was more common than symptomatic hypermobility. Maximum prevalence of hypermobility was in 6-9 year age group. Of the 94 children with hypermobility, 55.32% had some kind of joint pain. CONCLUSIONS Pediatric Gait, Arms, Legs, Spine is an acceptable screening tool for musculoskeletal abnormalities in apparently healthy children. Growing pain is the commonest musculoskeletal complaint while hypermobility is the commonest physical abnormality in school-going children in the Eastern Himalayas. Asymptomatic hypermobility is more common than symptomatic hypermobility.
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Affiliation(s)
- Tapas Kumar Sabui
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | - Moumita Samanta
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | | | - Indira Banerjee
- Department of Pediatric Medicine, North Bengal Medical College and Hospital, Darjeeling, India
| | - Abishek Saren
- Department of Pediatric Medicine, North Bengal Medical College and Hospital, Darjeeling, India
| | - Avijit Hazra
- Department of Pharmacology, IPGME&R and SSKM Hospital, Kolkata, India
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Azabagic S, Spahic R, Pranjic N, Mulic M. EPIDEMIOLOGY OF MUSCULOSKELETAL DISORDERS IN PRIMARY SCHOOL CHILDREN IN BOSNIA AND HERZEGOVINA. Mater Sociomed 2016; 28:164-7. [PMID: 27482154 PMCID: PMC4949050 DOI: 10.5455/msm.2016.28.164-167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/15/2016] [Indexed: 11/03/2022] Open
Abstract
Introduction: Musculoskeletal disorders represent a significant problem of modern society which are more pronounced in young people and school children. Etiology of these disorders is found in inadequate ergonomic conditions, too heavy school bag, school furniture inadequate to age, poor posture, sedentary lifestyle, reduction of physical activity and lack of exercise. Material and methods: This cross-sectional study included 1315 pupils aged 8- 12 years. As a method was used “cluster sample” in the selection of subjects. The survey was conducted by questionnaire containing information on the demographic and individual characteristics of participants (age, gender, class), the manner and style of life and the performance of school tasks, followed by standardized Nordic questionnaire. The following parameters were measured: body height and weight for each student, and the weight of full and empty school bag that students that day brought to class. Results: The incidence of musculoskeletal pain regardless of localization was 48%. There is a statistically significant correlation between acute pain in the right shoulder and total weight of school bags, duration of caring the bag in school and time of wearing bag from school to home but not with the manner in which school bag was carried. Acute pain in the right shoulder and acute neck pain were significantly associated with the duration of sitting in school or in front of a computer at home. Acute pain in the shoulder negatively correlated with BMI percentile value of the respondents. Acute pain in the neck is also significantly associated with the weight of a full school bags, as well as time spent sitting at home doing homework. Acute back pain is statistically significantly correlated with the weight of school bags and duration of sitting periods in school. Conclusion: The prevalence of musculoskeletal pain, particularly chronic pain in school children aged 8-12 years is high. Weight of school bags, manner in which the bag is carried to and from school, duration of carrying bags, time spent sitting in the school and in front of the computer, duration of sitting and posture during homework, body mass index are ergonomic reasons for the development of musculoskeletal pain.
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Affiliation(s)
- Selma Azabagic
- Institute of Public Health of Tuzla Canton, Tuzla, Bosnia and Herzegovina
| | - Razija Spahic
- Clinic of Pediatrics, University Clinic Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Nurka Pranjic
- Department of Occupational Medicine, Tuzla University School of Medicine, Tuzla, Bosnia and Herzegovina
| | - Maida Mulic
- Institute of Public Health of Tuzla Canton, Tuzla, Bosnia and Herzegovina
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de Boer RM, van Vlimmeren LA, Scheper MC, Nijhuis-van der Sanden MWG, Engelbert RHH. Is Motor Performance in 5.5-Year-Old Children Associated with the Presence of Generalized Joint Hypermobility? J Pediatr 2015; 167:694-701.e1. [PMID: 26190232 DOI: 10.1016/j.jpeds.2015.06.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the prevalence of generalized joint hypermobility (GJH) in Dutch children aged 5.5 years, and to examine the association between GJH and motor performance and development over time. STUDY DESIGN A prospective cohort of 249 children was recruited. GJH was assessed with the Beighton test at age 5.5 years. Motor performance was evaluated at age 2.0 years using the Bayley Scales of Infant Development, Second Edition and at age 5.5 years using the Movement Assessment Battery for Children-Second Edition (subscore categories: manual dexterity, aiming and catching, and static and dynamic balance). RESULTS In 249 children, the prevalence of GJH, defined by the Beighton test score, was 34.1% for a score ≥ 4, 22.5% for a score ≥ 5, and 16.5% for a score ≥ 6. No significant association was found between GJH and total motor performance. Manual dexterity in girls (Beighton score ≥ 4) was positively associated with higher level of motor performance (β [SE] = 0.38 [0.17]; P = .028), ranging from +0.04 SD to +0.72 SD, even after correction for covariates. A significant interaction between GJH and body mass index (BMI) growth was found, indicating that the effect of GJH on the rate of development of motor performance declines with increasing BMI growth (β = 0.05 [0.02]; P = .031). CONCLUSION In this healthy pediatric cohort, GJH was present in one-third of the sample, and no significant association was found between GJH and total motor performance. The effect of GJH on the rate of development of motor performance appears to decline with increasing BMI growth. Longitudinal prospective studies are recommended to detect influences of GJH on motor performance over time, as well as the influence of body composition and Beighton cutoff points.
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Affiliation(s)
- Rosa M de Boer
- Primary Practice for Pediatric Physiotherapy, Heerhugowaard, The Netherlands
| | - Leo A van Vlimmeren
- Department of Rehabilitation, Pediatric Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Mark C Scheper
- Education of Physiotherapy, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation, University Hospital Amsterdam (AMC), Amsterdam, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation, Pediatric Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raoul H H Engelbert
- Education of Physiotherapy, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation, University Hospital Amsterdam (AMC), Amsterdam, The Netherlands
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Al-Jarallah K, Shehab D, Al-Jaser MT, Al-Azemi KM, Wais FF, Al-Saleh AM, Al-Ajmi AS, Al-Omairah HA, Abraham M, Sharma PN. Prevalence of joint hypermobility in Kuwait. Int J Rheum Dis 2014; 20:935-940. [PMID: 25529052 DOI: 10.1111/1756-185x.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine the prevalence of joint hypermobility (JH) among young Kuwaiti adults. METHODS This was a cross-sectional study of 390 randomly selected healthy undergraduate university students, aged 18-29 years from the Health Sciences Centre, Kuwait University, Safat, Kuwait. Beighton score at four peripheral sites bilaterally (knees, elbows, thumbs and fifth fingers) and forward flexion of the trunk were used to evaluate joint hypermobility. Any student who met four out of the nine criteria was considered hypermobile. Joint pain was documented in all subjects through personal interview. RESULTS A total of 390 subjects (male : female ratio 1.0 : 0.9) were assessed. Of those, 87 (22.3%) were found to have JH: 60 (29.4%) males and 27 (14.5%) females, showing a significantly higher male predominance (P < 0.001). Beighton score was inversely correlated with age (ρ = -0.15, P = 0.003). A higher incidence of finger signs was noted in comparison to elbow-knee hyperextension and hands-to-floor. Knee joint, back, neck and shoulder pains, in descending order, were the commonest type of joint complaints, although not statistically significant (P > 0.05) in subjects with and without joint hypermobility. It was also observed that the left side, at all the sites, was slightly more hypermobile in comparison to the right side in hypermobile subjects. CONCLUSIONS The prevalence of joint hypermobility is not uncommon among young Kuwaiti adults, and was comparable to the data published in other Asian-Pacific regions. General practitioners should therefore be familiar with the condition and its clinical associations, while assessing musculoskeletal complaints.
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Affiliation(s)
- Khaled Al-Jarallah
- Department of Medicine, Kuwait University, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Diaa Shehab
- Department of Medicine, Kuwait University, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | | | - Fatma F Wais
- Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | | | | | - Mini Abraham
- Department of Medicine, Kuwait University, Safat, Kuwait.,Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Prem N Sharma
- Faculty of Medicine, Kuwait University, Safat, Kuwait
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Sohrbeck-Nøhr O, Kristensen JH, Boyle E, Remvig L, Juul-Kristensen B. Generalized joint hypermobility in childhood is a possible risk for the development of joint pain in adolescence: a cohort study. BMC Pediatr 2014; 14:302. [PMID: 25492414 PMCID: PMC4305244 DOI: 10.1186/s12887-014-0302-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/25/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is some evidence that indicates generalized joint hypermobility (GJH) is a risk factor for pain persistence and recurrence in adolescence. However, how early pain develops and whether GJH without pain in childhood is a risk factor for pain development in adolescence is undetermined. The aims for this study were to investigate the association between GJH and development of joint pain and to investigate the current GJH status and physical function in Danish adolescents. METHODS This was a longitudinal cohort study nested within the Copenhagen Hypermobility Cohort. All children (n = 301) were examined for the exposure, GJH, using the Beighton test at baseline at either 8 or 10 years of age and then re-examined when they reached 14 years of age. The children were categorized into two groups based on their number of positive Beighton tests using different cut points (i.e. GJH4 defined as either < 4 or ≥ 4, GJH5 and GJH6 were similarly defined). The outcome of joint pain was defined as arthralgia as measured by the Brighton criteria from the clinical examination. Other outcome measures of self-reported physical function and objective physical function were also collected. RESULTS Children with GJH had three times higher risk of developing joint pain in adolescence, although this association did not reach statistical significance (GJH5: 3.00, 95% [0.94-9.60]). At age 14, the adolescents with GJH had significantly lower self-reported physical function (for ADL: GJH4 p = 0.002, GJH5 p = 0.012; for pain during sitting: GJH4 p = 0.002, GJH5 p = 0.018) and had significantly higher body mass index (BMI: GJH5 p = 0.004, GJH6 p = 0.006) than adolescents without GJH. There was no difference in measured physical function. CONCLUSION This study has suggested a possible link between GJH and joint pain in the adolescent population. GJH was both a predictive and a contributing factor for future pain. Additional studies with larger sample sizes are needed to confirm our findings.
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Affiliation(s)
- Oline Sohrbeck-Nøhr
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark.
| | - Jens Halkjær Kristensen
- Department of Infectious Medicine and Rheumatology, University Hospital of Copenhagen, COHYPCO, 2100, Copenhagen Ø, Denmark.
| | - Eleanor Boyle
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Lars Remvig
- Department of Infectious Medicine and Rheumatology, University Hospital of Copenhagen, COHYPCO, 2100, Copenhagen Ø, Denmark.
| | - Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. .,Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway.
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Smith EMD, Ramanan AV. Fifteen-minute consultation: A structured approach to the management of hypermobility in a child. Arch Dis Child Educ Pract Ed 2013; 98:212-6. [PMID: 23864005 DOI: 10.1136/archdischild-2013-303882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To present a structured approach for an outpatient consultation of a child with hypermobility. METHOD Review of the literature and a description of the approach commonly adopted in a paediatric out-patient setting. CONCLUSIONS A focused history and examination is the key to reaching an appropriate differential diagnosis and planning management for children with hypermobility. CASE A 10-year-old child is referred to your general paediatric clinic with frequent 'cracking and clicking' of her joints and a history of intermittent aches and pains over the last 6 months.
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Affiliation(s)
- Eve M D Smith
- Paediatric Rheumatology Department, Great North Children's Hospital, , Newcastle Upon Tyne, UK
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Remvig L, Kümmel C, Kristensen JH, Boas G, Juul-Kristensen B. Prevalence of generalized joint hypermobility, arthralgia and motor competence in 10-year-old school children. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753615411y.0000000009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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McCluskey G, O'Kane E, Hann D, Weekes J, Rooney M. Hypermobility and musculoskeletal pain in children: a systematic review. Scand J Rheumatol 2012; 41:329-38. [DOI: 10.3109/03009742.2012.676064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Clinch J, Deere K, Sayers A, Palmer S, Riddoch C, Tobias JH, Clark EM. Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: a population-based evaluation. ACTA ACUST UNITED AC 2011; 63:2819-27. [PMID: 21547894 PMCID: PMC3164233 DOI: 10.1002/art.30435] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective Although diagnostic criteria for generalized ligamentous laxity (hypermobility) in children are widely used, their validity may be limited, due to the lack of robust descriptive epidemiologic data on this condition. The present study was undertaken to describe the point prevalence and pattern of hypermobility in 14-year-old children from a population-based cohort. Methods We performed a cross-sectional analysis using the Avon Longitudinal Study of Parents and Children, a large population-based birth cohort. Hypermobility among children in the cohort (mean age 13.8 years) was measured using the Beighton scoring system. Objective measures of physical activity were ascertained by accelerometry. Data on other variables, including puberty and socioeconomic status, were collected. Simple prevalence rates were calculated. Chi-square tests and logistic regression analyses were used to assess associations of specific variables with hypermobility. Results Among the 6,022 children evaluated, the prevalence of hypermobility (defined as a Beighton score of ≥4 [i.e., ≥4 joints affected]) in girls and boys age 13.8 years was 27.5% and 10.6%, respectively. Forty-five percent of girls and 29% of boys had hypermobile fingers. There was a suggestion of a positive association between hypermobility in girls and variables including physical activity, body mass index, and maternal education. No associations were seen in boys. Conclusion We have shown that the prevalence of hypermobility in UK children is high, possibly suggesting that the Beighton score cutoff of ≥4 is too low or that this scoring is not appropriate for use in subjects whose musculoskeletal system is still developing. These results provide a platform to evaluate the relationships between the Beighton criteria and key clinical features (including pain), thereby testing the clinical validity of this scoring system in the pediatric population.
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Affiliation(s)
- Jacqui Clinch
- Bristol Royal Hospital for Children, University of Bristol, Bristol, UK.
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Czaprowski D, Kotwicki T, Pawłowska P, Stoliński L. Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner. SCOLIOSIS 2011; 6:22. [PMID: 21981906 PMCID: PMC3204294 DOI: 10.1186/1748-7161-6-22] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/07/2011] [Indexed: 11/25/2022]
Abstract
Background Generalized joint hypermobility (JHM) refers to increased joint mobility with simultaneous absence of any other systemic disease. JHM involves proprioception impairment, increased frequency of pain within joints and tendency to injure soft tissues while performing physical activities. Children with idiopathic scoliosis (IS) often undergo intensive physiotherapy requiring good physical capacities. Further, some physiotherapy methods apply techniques that increase joint mobility and thus may be contraindicated. The aim of this paper was to assess JHM prevalence in children with idiopathic scoliosis and to analyze the relationship between JHM prevalence and the clinical and radiological parameters of scoliosis. The methods of assessment of generalized joint hypermobility were also described. Materials and methods This case-control study included 70 subjects with IS, aged 9-18 years (mean 13.2 ± 2.2), Cobb angle range 10°-53° (mean 24.3 ± 11.7), 34 presenting single curve thoracic scoliosis and 36 double curve thoracic and lumbar scoliosis. The control group included 58 children and adolescents aged 9-18 years (mean 12.6 ± 2.1) selected at random. The presence of JHM was determined using Beighton scale complemented with the questionnaire by Hakim and Grahame. The relationship between JHM and the following variables was evaluated: curve severity, axial rotation of the apical vertebra, number of curvatures (single versus double), number of vertebrae within the curvature (long versus short curves), treatment type (physiotherapy versus bracing) and age. Statistical analysis was performed with Statistica 8.1 (StatSoft, USA). The Kolmogorov-Smirnov test, U Mann-Whitney test, Chi2 test, Pearson and Spermann correlation rank were conducted. The value p = 0.05 was adopted as the level of significance. Results JHM was diagnosed in more than half of the subjects with idiopathic scoliosis (51.4%), whilst in the control group it was diagnosed in only 19% of cases (p = 0.00015). A significantly higher JHM prevalence was observed in both girls (p = 0.0054) and boys (p = 0.017) with IS in comparison with the corresponding controls. No significant relation was found between JHM prevalence and scoliosis angular value (p = 0.35), apical vertebra rotation (p = 0.86), the number of vertebrae within curvature (p = 0.8), the type of applied treatment (p = 0.55) and the age of subjects (p = 0.79). JHM prevalence was found to be higher in children with single curve scoliosis than in children with double curve scoliosis (p = 0.03). Conclusions JHM occurs more frequently in children with IS than in healthy sex and age matched controls. No relation of JHM with radiological parameters, treatment type and age was found. Systematically searched in IS children, JHM should be taken into account when physiotherapy is planned.
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Affiliation(s)
- Dariusz Czaprowski
- Faculty of Physiotherapy, Józef Rusiecki University College in Olsztyn, 10-243 Olsztyn, Bydgoska 33, Poland.
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Fatoye F, Palmer S, Macmillan F, Rowe P, van der Linden M. Pain intensity and quality of life perception in children with hypermobility syndrome. Rheumatol Int 2011; 32:1277-84. [PMID: 21267571 DOI: 10.1007/s00296-010-1729-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 12/30/2010] [Indexed: 11/24/2022]
Abstract
Hypermobility syndrome (HMS) is a major source of morbidity in children. Impaired quality of life (QoL) has been observed recently in adults with HMS; however, this issue is yet to be investigated in children with this condition. This study compared pain intensity and QoL in children with HMS with healthy controls. It also examined the relationship between pain intensity and QoL in children with HMS. Following ethical approval, 29 children diagnosed with HMS and 37 healthy children aged 8-15 years participated. Informed written consent was obtained from participants and their parents/guardians. Average knee pain over the past week was examined using the Coloured Analogue Scale. QoL was measured via the Pediatric Quality of Life Inventory. Mann-Whitney U tests were performed to compare pain and QoL scores between the two groups. Spearman Rho correlation analysis was performed to examine the relationship between pain and QoL. Overall QoL scores in each domain were significantly lower in children with HMS (all p < 0.001) compared with the controls. Pain intensity was significantly higher in children with HMS compared with their healthy counterparts (p < 0.001). A strong negative correlation was observed between pain intensity and overall QoL and all the domains (r range = -0.614 to -0.717; all p < 0.001). In conclusion, the findings of the present study imply that pain and QoL assessment might form important components of clinical examination for children diagnosed with HMS. These children may benefit from appropriate treatment programmes to alleviate pain intensity and improve QoL.
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, School of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Hathersage Road, Manchester, M13 0JA, UK.
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Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr 2011; 158:119-23, 123.e1-4. [PMID: 20850761 DOI: 10.1016/j.jpeds.2010.07.021] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 06/15/2010] [Accepted: 07/13/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the validity of the Beighton score as a generalized measure of hypermobility and to measure the prevalence of hypermobility and pain in a random population of school age children. STUDY DESIGN Prospective study of 551 children attending various Dutch elementary schools participated; 47% were males (258) and 53% (293) females, age range was 6 to 12 years. Children's joints and movements were assessed according to the Beighton score by qualified physiotherapists and by use of goniometry measuring 16 passive ranges of motion of joints on both sides of the body. RESULTS More than 35% of children scored more than 5/9 on the Beighton score. Children who scored high on the Beighton score also showed increased range of motion in the other joints measured. Moreover 12.3% of children had symptoms of joint pain, and 9.1% complained of pain after exercise or sports. Importantly, this percentage was independent of the Beighton score. There were no significant differences in Beighton score for sex in this population. CONCLUSION The Beighton score, when goniometry is used, is a valid instrument to measure generalized joint mobility in school-age children 6 to 12 years. No extra items are needed to improve the scale.
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Affiliation(s)
- Bouwien Smits-Engelsman
- Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Avans, University for Professionals, Breda, The Netherlands.
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Zurita Ortega F, Ruiz Rodríguez L, Martínez Martínez A, Fernández Sánchez M, Rodríguez Paiz C, López Liria R. [Hiperlaxity ligamentous (Beighton test) in the 8 to 12 years of age school population in the province of Granada]. REUMATOLOGIA CLINICA 2010; 6:5-10. [PMID: 21794671 DOI: 10.1016/j.reuma.2009.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 12/18/2008] [Accepted: 01/08/2009] [Indexed: 11/25/2022]
Abstract
The Beighton test is the most commonly used tool for detecting ligamentous hiperlaxity, characterized by excessive joint mobility. This descriptive-transversal study examines a sample of 2956 children (49,9% boys and 50,1% girls), from eight to twelve years of age, living in the province of Granada, The study aims to show the incidence level of hiperlaxity among the school-aged population, while establishing its frequency in relation to gender and age, and determining the area with the highest number of cases within the province of Granada. The Beighton test was used for data collection. The sample showed that 25, 4% of individuals got a positive Beighton result (laxity), and girls had a higher incidence level (62,1%) than boys. The results show as well a similar level of incidence among boys and girls between eight and ten years of age; however, the incidence decreases among younger children (under 8 years). Regarding the geographical areas, the distribution is quite heterogeneous, but we were able to highlight the difference between a result of 50% in Area 4 and 12% in Area 2, due to genetic and racial factors. In conclusion, the results obtained through this study show a lower hiperlaxity incidence compared to the results found in the American continent and they are slightly higher than those from other European and African countries.
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Affiliation(s)
- Félix Zurita Ortega
- Escuela Universitaria de Ciencias de la Salud, Universidad de Almería, España
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Juul-Kristensen B, Kristensen JH, Frausing B, Jensen DV, Røgind H, Remvig L. Motor competence and physical activity in 8-year-old school children with generalized joint hypermobility. Pediatrics 2009; 124:1380-7. [PMID: 19822597 DOI: 10.1542/peds.2009-0294] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Because the criteria used for diagnosing between generalized joint hypermobility (GJH) and musculoskeletal complaints, as well as relations between GJH and an insufficient motor development and/or a reduced physical activity level differ, the prevalence of GJH varies considerably. The aim of this study was to survey the prevalence of GJH defined by a Beighton score at >or=4, >or=5, or >or=6 positive tests of 9 and benign joint hypermobility syndrome (BJHS) in Danish primary school children at 8 years of age. A second aim was to compare children with and without GJH and BJHS regarding motor competence, self-reported physical activity, and incidence of musculoskeletal pain and injuries. METHODS A cross-sectional study of 524 children in the second grade from 10 public schools was performed. A positive response rate was obtained for 416 (79.4%) children, and 411 (78.4%) children were clinically examined and tested for motor competence, whereas questionnaire response to items comprising musculoskeletal pain and injuries, in addition to daily level and duration of physical activity, corresponded to 377 (71.9%) children. RESULTS In total, 29% of the children had GJH4, 19% had GJH5, 10% had GJH6, and 9% had BJHS, with no gender difference. There was no difference in daily level and duration of physical activity and in frequency of musculoskeletal pain and injuries between those with and without GJH. Children with >or=GJH5 as well as with >or=GJH6 performed better in the motor competence tests. CONCLUSION Motor competence and physical activity are not reduced in primary school children at 8 years of age with GJH or BJHS. It is recommended that a potential negative influence on the musculoskeletal system over time, as a result of GJH, be investigated by longitudinal studies.
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High hand joint mobility is associated with radiological CMC1 osteoarthritis: the AGES-Reykjavik study. Osteoarthritis Cartilage 2009; 17:592-5. [PMID: 19010064 PMCID: PMC2756801 DOI: 10.1016/j.joca.2008.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 10/09/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Previous studies have indicated that joint hypermobility may affect the development of clinical and radiological hand osteoarthritis (OA), but this question has not been addressed in epidemiological studies. Our objective was to investigate this relationship in a population-based study. PATIENTS AND METHODS The study group consisted of 384 unselected older participants in the Age, Gene/Environment Susceptibility-Reykjavik Study (161 males, median age 76, range 69-90, and 223 females median age 75, range 69-92). The criterion used for joint mobility was the single maximal degree of hyperextension of digits 2 and 5 on both hands (HYP degrees). RESULTS HYP degrees was more prevalent in females and on the left hand in both men and women. Both genders had a positive association between the degree of mobility measured by HYP degrees and radiological scores for the first carpometacarpal joint (CMC1) OA. Thus, those with HYP degrees >or=70 had an odds ratio of 3.05 (1.69-5.5, P<0.001) of having a Kellgren-Lawrence score of >or=3 in a CMC1 joint. There was also a trend towards a negative association between HYP degrees and proximal interphalangeal joint scores. CONCLUSION Hand joint mobility, defined as hyperextension in the metacarpophalangeal joints (HYP degrees ) is more prevalent in females and on the left side. It was associated with more severe radiographic OA in the CMC1 joints in this population. The reasons for this relationship are not known, but likely explanations involve ligament laxity and CMC1 joint stability. These findings may relate to the left-sided predominance of radiographic OA in the CMC1 joints observed in many prevalence studies.
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Yazgan P, Geyikli İ, Zeyrek D, Baktiroglu L, Kurcer MA. Is joint hypermobility important in prepubertal children? Rheumatol Int 2008; 28:445-51. [DOI: 10.1007/s00296-008-0528-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 01/01/2008] [Indexed: 11/28/2022]
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Simmonds JV, Keer RJ. Hypermobility and the hypermobility syndrome. ACTA ACUST UNITED AC 2007; 12:298-309. [PMID: 17643337 DOI: 10.1016/j.math.2007.05.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 03/06/2007] [Accepted: 05/12/2007] [Indexed: 11/30/2022]
Abstract
Hypermobile joints by definition display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility, when associated with symptoms is termed the joint hypermobility syndrome or hypermobility syndrome (JHS). JHS is an under recognised and poorly managed multi-systemic, hereditary connective tissue disorder, often resulting in a great deal of pain and suffering. The condition is more prevalent in females, with symptoms frequently commencing in childhood and continuing on into adult life. This paper provides an overview of JHS and suggested clinical guidelines for both the identification and management of the condition, based on research evidence and clinical experience. The Brighton Criteria and a simple 5-point questionnaire developed by Hakim and Grahame, are both valid tools that can be used clinically and for research to identify the condition. Management of JHS frequently includes; education and lifestyle advice, behaviour modification, manual therapy, taping and bracing, electrotherapy, exercise prescription, functional rehabilitation and collaborative working with a range of medical, health and fitness professionals. Progress is often slow and hampered by physical and emotional setbacks. However with a carefully considered management strategy, amelioration of symptoms and independent functional fitness can be achieved.
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Affiliation(s)
- Jane V Simmonds
- University of Hertfordshire, School of Health and Emergency Professions, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK.
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Non-specific neck pain in schoolchildren: prognosis and risk factors for occurrence and persistence. A 4-year follow-up study. Pain 2007; 137:316-322. [PMID: 17964722 DOI: 10.1016/j.pain.2007.09.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 07/17/2007] [Accepted: 09/12/2007] [Indexed: 11/22/2022]
Abstract
This study investigated the natural course of neck pain (NP) in 9-12-year-olds during a 4-year follow-up. Risk factors for the occurrence and persistence of weekly NP were explored separately for boys and girls. At baseline, 1756 schoolchildren completed a questionnaire eliciting musculoskeletal pain symptoms, other physical, and psychological symptoms and frequency of physical activity, and were tested for joint hypermobility. Symptoms during the preceding three months were asked using a five-level frequency classification. Re-evaluation was performed after one and four years using identical questionnaires. During follow-up, 24% reported none, 71% fluctuating, and 5% persistent weekly NP. The frequency of NP at baseline was linearly related to weekly NP during follow-up in both genders (P<0.001). Furthermore, a significant increasing linear trend towards a more persistent course of NP was seen in children with weekly other musculoskeletal and/or other physical and psychological symptoms at baseline. Among originally neck pain-free pre-/early adolescents, weekly other musculoskeletal pain symptoms (only in girls) and other physical and psychological symptoms (in both genders) predicted the occurrence of weekly NP during follow-up. In conclusion, neck pain in schoolchildren tends to fluctuate, but there also seems to exist a subgroup (5%) with persistent NP already in pre-/early adolescents, or even earlier. Co-occurrence of frequent other musculoskeletal symptoms and/or markers of psychological stress with frequent NP are risk indicators for a more persistent course, at least within next few years. Since adult chronic NP problems might originate in childhood, further studies are needed, including preventive interventions.
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El-Metwally A, Salminen JJ, Auvinen A, Macfarlane G, Mikkelsson M. Risk factors for development of non-specific musculoskeletal pain in preteens and early adolescents: a prospective 1-year follow-up study. BMC Musculoskelet Disord 2007; 8:46. [PMID: 17521435 PMCID: PMC1891107 DOI: 10.1186/1471-2474-8-46] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 05/23/2007] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Musculoskeletal pain symptoms are common in children and adolescents. These symptoms have a negative impact on children's physical and emotional well-being, but their underlying aetiology and risk factors are still poorly understood. Most of the previous cohort studies were conducted among mid and/or late adolescents and were mainly focused on a specific pain location (e.g. low back pain or neck pain). The purpose of this study is to estimate occurrence of new-onset pain symptoms, in all musculoskeletal locations, in preteens and early adolescents and investigate risk factors for development of these symptoms. METHODS 1756 schoolchildren (mean age 10.8) were recruited from schools in southern Finland. Information was extracted as to whether they experienced musculoskeletal pain and a total of 1192 children were identified as free of musculoskeletal pain symptoms. Information was collected on factors which could potentially predict the development of musculoskeletal pain: headache, abdominal pain, sadness/feeling down, day-time tiredness, difficulty in falling asleep, waking up during nights, level of physical activity and hypermobility. These children were followed-up 1-year later and those with new episodes of non-traumatic and traumatic musculoskeletal pain symptoms were identified. RESULTS A total of 1113 schoolchildren (93% of baseline pain-free children) were found at one-year follow-up. New episodes of musculoskeletal pain were reported by 21.5% of these children. Of them 19.4% reported non-traumatic pain and 4.0% reported traumatic pain. The neck was the most commonly reported site with non-traumatic pain, while the lower limb was the most common site for traumatic pain. The independent risk factors for non-traumatic musculoskeletal pain were headache (OR = 1.68, [95% CI 1.16-2.44]) and day-time tiredness (OR = 1.53, [95% CI 1.03-2.26]). The risk factors for traumatic musculoskeletal pain were vigorous exercise (OR = 3.40 [95% CI 1.39-8.31]) and day-time tiredness (OR = 2.97 [95% CI 1.41-6.26]). CONCLUSION This study highlights that there may be two types of pain entities with both distinct and common aspects of aetiology. For primary prevention purposes, school healthcare professionals should pay attention to preteens and early adolescents practicing vigorous exercise (predictor of traumatic pain), reporting headache (predictor of non-traumatic pain) and reporting day-time tiredness (predictor of both types of pain).
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Affiliation(s)
- Ashraf El-Metwally
- Department of Physical and Rehabilitation Medicine, The Rheumatism Foundation Hospital, Pikijärventie 1, 18120 Heinola, Finland
- Epidemiology Group, Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
- Tampere School of Public Health, FIN-33014 University of Tampere, Tampere, Finland
| | - Jouko J Salminen
- Department of Physical and Rehabilitation Medicine, University Hospital of Turku, P.O box 52, 20520 Turku, Finland
| | - Anssi Auvinen
- Tampere School of Public Health, FIN-33014 University of Tampere, Tampere, Finland
- Pediatric Research Center, Tampere University Hospital, FIN-33014, Tampere, Finland
| | - Gary Macfarlane
- Epidemiology Group, Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Marja Mikkelsson
- Department of Physical and Rehabilitation Medicine, The Rheumatism Foundation Hospital, Pikijärventie 1, 18120 Heinola, Finland
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Hakim AJ, Sahota A. Joint hypermobility and skin elasticity: the hereditary disorders of connective tissue. Clin Dermatol 2006; 24:521-33. [PMID: 17113970 DOI: 10.1016/j.clindermatol.2006.07.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The hereditary disorders of connective tissues (HDCTs) encompass a spectrum of conditions linked pathophysiologically by abnormalities of collagen, fibrillin, and matrix proteins. The clinical picture ranges from morbidity because of musculoskeletal, skin, ocular and visceral pathologies to mortality from acute vascular collapse. For many of the conditions, there is a considerable overlap in clinical features, although severity varies; appreciating the subtle differences in presentation is vital to the clinician in determining the diagnosis. Though conditions associated with severe vascular pathology are rare, other hereditary disorders of connective tissues such as the joint hypermobility syndrome and Stickler's disease are common and probably underrecognized. Abnormal skin elasticity and scaring, joint hypermobility, and chronic arthralgia are important clues that should trigger the clinician to search for underlying hereditary disorders of connective tissues. In this article, we discuss the spectrum of clinical findings, management, and genetic screening of the more common hereditary disorders of connective tissues, highlighting their diagnostic criteria and their differences.
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Affiliation(s)
- Alan J Hakim
- Department of Rheumatology, Whipps Cross University Hospital, Leytonstone, London, UK.
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Abstract
It is well recognized that many if not most children and adolescents attending paediatric rheumatology clinics will have a non-inflammatory origin for their complaints or disorder. Mechanical causes are frequently identified, and hypermobility or ligamentous laxity of joints is increasingly recognized as an aetiological factor in the presentation. Such conditions include 'growing pains', recurrent lower-limb arthralgia, anterior knee pain syndromes, and back pain. Studies of significant cohorts of such patients have now been published supporting the link of ligamentous laxity to particular symptom complexes. However, much disagreement remains as to the validity of hypermobility as an aetiogical factor. What seems clear is that not all hypermobile individuals will be symptomatic or indeed possibly have any risk for specific musculoskeletal disorders in later life. Screening tools such as the Beighton score are likely to be inadequate in many paediatric populations. Along with increasing recognition of these disorders in childhood and adolescence has been the development of a multidisciplinary management approach, which usually involves predominantly allied health professionals such as podiatrists, physiotherapists and occupational therapists. The challenge remains to interpret symptoms correctly as being related to the hypermobility and to predict why such children become symptomatic. The answer is likely to involve physiological and psychosocial factors. In addition, early identification and modification of risk factors may have major implications for subsequent prevalence of many adult medical disorders such as low back pain, chronic pain syndromes and degenerative osteoarthritis.
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Affiliation(s)
- Kevin J Murray
- Princess Margaret Hospital, G.P.O. Box D184, Perth 6840, WA, Australia.
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Abstract
A wide range of conditions comes under the umbrella of paediatric rheumatology. These problems are common in childhood and cover a wide variety of presentations and outcomes. Many conditions are benign and self-limiting, others run a chronic relapsing and remitting course; some are fatal. Broadly, rheumatological problems can be subdivided into inflammatory, mechanical, and behaviourally or psychologically driven aetiologies, although these are not mutually exclusive. The majority of patients with rheumatological conditions will present with symptoms that are easily localized to the musculoskeletal system. Sometimes, however, a child with a rheumatological condition may present less specifically: for example with fatigue, deterioration in school performance or growth retardation. In this case a rheumatological aetiology may be overlooked unless it is specifically suspected and a careful assessment for musculoskeletal symptoms and signs is undertaken. In order to arrive at the correct diagnosis and plan appropriate further management, it is therefore important for the clinician both to have an effective system to ensure that musculoskeletal symptoms are appropriately determined and assessed, and to be aware of the wide range of conditions, which can cause such symptoms in childhood and adolescence. The keys to this lie in acquiring the clinical skills necessary to accurately assess such patients and awareness of the changing differential diagnosis with the age of the child. In this chapter, we aim to address these issues, initially by discussing the prevalence of musculoskeletal symptoms in children and adolescents and the various conditions which cause them, and subsequently by looking at common presentations of rheumatic disease in childhood and suggesting an approach to diagnosis in each case.
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Affiliation(s)
- Karen Davies
- Paediatric Rheumatology Department, New Cross Hospital, Wolverhampton, WV10 0QP, UK.
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Sendur OF, Gurer G, Yildirim T, Ozturk E, Aydeniz A. Relationship of Q angle and joint hypermobility and Q angle values in different positions. Clin Rheumatol 2005; 25:304-8. [PMID: 16208428 DOI: 10.1007/s10067-005-0003-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 05/03/2005] [Accepted: 05/03/2005] [Indexed: 01/31/2023]
Abstract
Patellar malalignment is the most important reason for anterior knee pain. Patellar alignment is commonly determined by the measurement of the quadriceps (Q) angle. In this study, our primary aim was to investigate the Q angle difference between healthy individuals with and without joint hypermobility. The other objectives were to compare the Q angle values, which were measured in supine and upright positions, to determine hypermobility frequency among healthy males in a certain population, and to investigate the correlation between the existent skeletal deformities and Beighton score levels. Two hundred fifty-three healthy male college students were examined for hypermobility and skeletal deformities. According to the Beighton scoring system, three groups (n=20) were formed, and Q angle measurements were performed on the 60 individuals in both supine and upright positions. In the comparison of the groups, the mean Q angle values in healthy hypermobile individuals were found to be significantly higher than that of the nonhypermobile ones (p<0.05). No statistical difference was found between Q angle values in supine and upright positions (p>0.05). The frequency of joint hypermobility (Beighton score 4 or more) was found to be 29.25% in this population. No correlation was determined between existent skeletal deformities and Beighton score values (p>0.05). In conclusion, the Q angle evaluation among healthy hypermobile individuals may have a prognostic value for probable knee pathologies that may appear in the future.
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Affiliation(s)
- Omer Faruk Sendur
- Department of Physical Therapy and Rehabilitation, Adnan Menderes University Medical School, 09100 Aydin, Turkey.
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Adib N, Davies K, Grahame R, Woo P, Murray KJ. Joint hypermobility syndrome in childhood. A not so benign multisystem disorder? Rheumatology (Oxford) 2005; 44:744-50. [PMID: 15728418 DOI: 10.1093/rheumatology/keh557] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Joint hypermobility (JH) or "ligamentous laxity" is felt to be an underlying risk factor for many types of musculoskeletal presentation in paediatrics, and joint hypermobility syndrome (JHS) describes such disorders where symptoms become chronic, often more generalized and associated with functional impairment. Clinical features are felt to have much in common with more severe disorders, including Ehlers-Danlos syndrome (EDS), osteogenesis imperfecta and Marfan syndrome, although this has not been formally studied in children. We defined the clinical characteristics of all patients with joint hypermobility-related presentations seen from 1999 to 2002 in a tertiary referral paediatric rheumatology unit. METHODS Patients were identified and recruited from paediatric rheumatology clinic and ward, and a dedicated paediatric rheumatology hypermobility clinic at Great Ormond Street Hospital. Data were collected retrospectively on the patients from the paediatric rheumatology clinics (1999-2002) and prospectively on patients seen in the hypermobility clinic (2000-2002). Specifically, historical details of developmental milestones, musculoskeletal or soft tissue diagnoses and symptoms, and significant past medical history were recorded. Examination features sought included measurements of joint and soft tissue laxity, and associated conditions such as scoliosis, dysmorphic features, cardiac murmurs and eye problems. RESULTS One hundred and twenty-five children (64 females) were included on whom sufficient clinical data could be identified and who had clinical problems ascribed to JH present for longer than 3 months. Sixty-four were from the paediatric rheumatology clinic and 61 from the hypermobility clinic. No differences were found in any of the measures between the two populations and results are presented in a combined fashion. Three-quarters of referrals came from paediatricians and general practitioners but in only 10% was hypermobility recognized as a possible cause of joint complaint. The average age at onset of symptoms was 6.2 yr and age at diagnosis 9.0 yr, indicating a 2- to 3-yr delay in diagnosis. The major presenting complaint was arthralgia in 74%, abnormal gait in 10%, apparent joint deformity in 10% and back pain in 6%. Mean age at first walking was 15.0 months; 48% were considered "clumsy" and 36% as having poor coordination in early childhood. Twelve per cent had "clicky" hips at birth and 4% actual congenital dislocatable hip. Urinary tract infections were present in 13 and 6% of the female and male cases, respectively. Thirteen and 14%, respectively, had speech and learning difficulties diagnosed. A history of recurrent joint sprains was seen in 20% and actual subluxation/dislocation of joints in 10%. Forty per cent had experienced problems with handwriting tasks, 48% had major limitations of school-based physical education activities, 67% other physical activities and 41% had missed significant periods of schooling because of symptoms. Forty-three per cent described a history of easy bruising. Examination revealed that 94% scored > or =4/9 on the Beighton scale for generalized hypermobility, with knees (92%), elbows (87%), wrists (82%), hand metacarpophalangeal joints (79%), and ankles (75%) being most frequently involved. CONCLUSIONS JHS is poorly recognized in children with a long delay in the time to diagnosis. Although there is a referral bias towards joint symptoms, a surprisingly large proportion is associated with significant neuromuscular and motor development problems. Our patients with JHS also show many overlap features with genetic disorders such as EDS and Marfan syndrome. The delay in diagnosis results in poor control of pain and disruption of normal home life, schooling and physical activities. Knowledge of the diagnosis and simple interventions are likely to be highly effective in reducing the morbidity and cost to the health and social services.
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Affiliation(s)
- N Adib
- Arthritis Research Campaign Unit, School of Epidemiology, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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de Inocencio Arocena J, Ocaña Casas I, Benito Ortiz L. [Joint hypermobility: prevalence and relationship with musculoskeletal pain]. An Pediatr (Barc) 2004; 61:162-6. [PMID: 15274882 DOI: 10.1016/s1695-4033(04)78375-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES (1) To determine the prevalence of joint hypermobility in children aged 4-14 years old without organic disease of the locomotor system; (2) to compare the prevalence of hypermobility in children with and without arthralgia and (3) to analyze the influence of certain variables on the development of arthralgia. PATIENTS AND METHODS We performed an observational study in a sample of children aged 4-14 years old living in Area 4 of the Community of Madrid (Spain). Joint hypermobility was evaluated using a goniometer. Hypermobility was defined using Beighton's criteria. RESULTS A total of 222 subjects were analyzed: 176 in the primary care setting and 46 in the emergency department of a referral hospital. Of the 222 children, 43 reported arthralgia. The prevalence of hypermobility (> or = 4 criteria) was 55 % (123/222), reaching 71 % (49/69) in children aged less than 8 years. No significant differences were found in the prevalence of hypermobility in children with and without arthralgia (65 % and 53 % respectively). Of the variables analyzed (age, sex, country of origin, primary care/emergency department setting) only differences in the absolute number of Beighton criteria present in children with and without arthralgia (4.34 +/- 2.47 and 3.48 +/- 2.35, p = 0.03) were detected, which disappeared when at least four criteria (definition of hypermobility) were required. CONCLUSIONS Fifty-five percent of the population studied and 71 % of those younger than 8 years old met the criteria for joint hypermobility. In the sample analyzed, the presence of joint hypermobility did not seem to favor the development of arthralgias.
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Affiliation(s)
- J de Inocencio Arocena
- Centro de Salud Estrecho de Corea, Instituto Madrileño de la Salud Atención Primaria Area 4, Madrid, Spain.
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Barron DF, Cohen BA, Geraghty MT, Violand R, Rowe PC. Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls. J Pediatr 2002; 141:421-5. [PMID: 12219066 DOI: 10.1067/mpd.2002.127496] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether children with chronic fatigue syndrome (CFS) have a higher prevalence of joint hypermobility than gender-matched controls. STUDY DESIGN Matched case-control study comparing the Beighton joint hypermobility scores in 58 consecutive children with CFS (incident cases) with 58 otherwise healthy controls referred to a dermatology clinic for evaluation of common skin problems. A second group of 58 patients previously diagnosed with CFS (prevalent cases) was matched by gender to the incident cases to evaluate temporal changes in referral patterns. RESULTS Of the 58 patients in each group, 71% were female. The median Beighton scores were higher in incident CFS cases than in healthy controls (4 vs 1, P <.001). More incident CFS cases had Beighton scores >/=4 (consistent with joint hypermobility), 60% versus 24%, P <.0001. Incident and prevalent CFS cases had similar Beighton scores. The odds ratio for hypermobility in all patients with CFS versus healthy controls was 3.5 (P <.001; 95% CI, 1.6-7.5). CONCLUSIONS Joint hypermobility is more common in patients with CFS than in otherwise healthy children with common skin disorders. The etiologic significance of the observed association remains to be defined.
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Affiliation(s)
- Diana F Barron
- Department of Pediatrics, and the McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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Duró JC, Vega E. Prevalence of articular hypermobility in schoolchildren: a one-district study in Barcelona. Rheumatology (Oxford) 2000; 39:1153. [PMID: 11035138 DOI: 10.1093/rheumatology/39.10.1153-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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